Case study 2 - assessment and treatment.

Assessment of the wound showed the following results:

  • Vascular assessment: No arterial occlusions.

  • Infection: CRP: 253.7 mg/L; Patient has fever.

Result of bacterial sampling bone biopsy:

Staphylococcus aureus +++

Streptococcus viridans +++

Enterococcus faecalis +++

  • X-Ray: Old calcaneum fracture and strong inflammation present.

An x-ray of the wounded foot.

Spreading infection was present and was slowly evolving into a systemic infection with sepsis. As a result, treatment mainly involved aggressive debridement. Surgical debridement was performed in combination with bone biopsy for bacterial sampling.

Further local therapy included a necessity for thorough cleansing and disinfection of the wound. Negative Pressure Wound Therapy (NPWT) with instillation (polihexidine solution 4x/day) was started. Systemic broad spectrum antibiotic treatment was administered to also cover anaerobic bacteria. After the results of the bone biopsy were known, antibiotic treatment was switched to a glycopeptide antibiotic and levofloxacin. Any pressure on foot was forbidden; the patient’s movement was restricted and was kept bed- and wheelchair- ridden.

An image of the foot 1 week after starting NPWT treatment.

Result after 1 week of NPWT with instillation

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Antimicrobial Stewardship in Wound Management

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